Mixed Global Progress against AIDS Annual UN Report Notes Problems in Africa, Improvements in US and Europe

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The disease known as AIDS continues to spread rapidly in much of the world. But it is declining significantly in places where AIDS awareness is high, causing people to change the behaviors that put them at risk.

As the United Nations observes the 10th annual World AIDS Day today, those countries where AIDS awareness programs are implemented and backed by government clout - including most rich and some poor countries - have made progress against the disease.

In the United States, the largest drop in AIDS (acquired immune deficiency syndrome) cases has been among homosexual men, "the very group which sought and benefited from the most open exchange of information about the risks of unprotected sex in the early years of the epidemic," said Peter Piot, executive director of the Joint United Nations Program on HIV/AIDS (UNAIDS), at a press conference in Paris last week. But the AIDS epidemic remains a massive and growing imposition on the lives of people in the developing world, where a UN report released last week estimates that 90 percent of the people with HIV or AIDS live. The spread of AIDS in countries such Brazil, Zimbabwe, and Thailand is reversing progress in quality of life, says a new World Bank study, independent of the UN report. The UN report estimates that globally: * Of an estimated 30.6 million people living with HIV/AIDS today, two-thirds live in Sub-Saharan Africa. * Sexually active adults are the most at risk, doctors say. An estimated 1 in 100 adults in the 15 to 49 age group have HIV. Even so, the UN estimates nearly 1.1 million children under the age of 15 are also living with AIDS. * Some 16,000 people get the AIDS virus every day of the year, says the report. Only 1 in 10 are aware of their HIV status. But experts also note vast differences in the way AIDS spreads in each region and nation. In sub-Saharan Africa, the most common mode of transmission is heterosexual contact. The southern part of the continent continues to be the worst affected by HIV. In South Africa, for instance, 2.4 million citizens live with HIV, up by more than a third over 1996. In Zimbabwe, nearly 1 in 5 adults has the HIV virus. But education programs that teach people to avoid intravenous drugs and sexual promiscuity appear to have a dramatic effect. Even in eastern Africa, site of one of the first AIDS outbreaks in the 1970s, Uganda has reported a decline in infection rates. Uganda's example The decline has been most marked among younger Ugandans, an indication that young people are adopting safer sexual behavior than was common a decade ago. For its part, western Europe has become somewhat of a role model in the fight against AIDS. Doctors there expect to find 30 percent fewer new AIDS cases in 1997 than they did in 1995. (The United States also cited a 6 percent decline in new AIDS cases last year, and expects a similar decline this year.) The forces behind this overall decline range from more aggressive medical treatments - fewer HIV cases are developing into AIDS - to simple changes in habits and hygiene, says Mr. Piot of UNAIDS. Promoting baby formula instead of breast-feeding, for example, has helped lower mother-to-child transmission of the disease, experts say. First-world wealth has helped as well. "Things are looking better here because they're richer and they can afford the ... treatment," says Karin Blanc at the Geneva-based UNAIDS. Medical treatment can cost as much as $15,000 a year per patient. But on the proactive side, education also plays a major role. The greatest decline in new AIDS cases has been among homosexual men, in whom HIV rates have been dropping for some years, and AIDS activists attribute that change in large part to greater awareness about prevention. …